We need to talk more about the realities of the fourth trimester

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Every woman who gives birth will experience the so-called fourth trimester: the weeks and months directly after childbirth when transitioning from pregnancy to a new mum. So why is it so rarely talked about before birth?
When I gave birth to my daughter, I was prepared for pretty much everything. The nursery was ready and waiting. The hospital bags were packed, the snacks primed and ready, the birth plan dutifully filled in. Even the pain of labor — so intense that at times I questioned how I’d actually survive it — didn’t phase me.
After all, I knew I wasn’t exactly checking in for a spa treatment, and the labor itself served a logical purpose, with every rolling wave of pain a necessary endurance test to get me one step closer to meeting my baby girl.
I was also ready for what to look out for with my daughter, too. From feeding cues to telltale indicators of colic, I felt confident I could, or at least try to, anticipate and understand her needs.
colic
What I hadn’t prepared for, however, was how to understand my needs after the birth, in the limbo land nicknamed the fourth trimester.
This is the topsy-turvy chunk of time immediately after birth, where your body is recovering and repairing itself after 9 months of growth and the trauma of childbirth.
The fourth trimester is when the typical woman is arguably at her most vulnerable, and yet it’s also the moment when she’s discharged from care and waved off into the sunset with her newborn. The bit that the books I’d read conveniently finished before, that the pre-birth classes I’d so diligently attended via Zoom with my husband hadn’t quite had time to mention.
Common side effects
The fourth trimester varies for every woman, with no two experiencing the same range of side effects. Some of these are obvious, such as bleeding, wound recovery (be it a cesarean delivery or stitches from a tear and/or episiotomy), and the infamous exhaustion that can come hand in hand with a newborn. But others are not so obvious.
cesarean delivery
Other side effects experienced by women after birth can include:
prolapses, triggered by a weakened pelvic floor
prolapses
breast pain, ranging from cracked nipples to mastitis
mastitis
diastasis recti: the separation of the stomach muscles, resulting in the so-called “tummy gap”
hair loss, brought on by hormonal changes
the baby blues
postnatal depression, which can affect anywhere from 10–15% of new mums
postnatal depression
From a personal perspective, I quickly realized that I had no clue about what would happen during the fourth trimester.
What I quickly realized after my birth experience is that no one discusses what happens to your body in the fourth trimester. You’re effectively handed your newborn, told to take some pain relief, and waved off into the sunset.
You’re no longer privy to the same level of medical scrutiny you were under during pregnancy. In the United Kingdom, beyond a couple of health visitor appointments in the early days and a 6-week checkup with your GP, you’re effectively left to just get on with it.
I was so ill-prepared for the physical realities of life after birth that I assumed:
I’d have a posing-on-the-steps moment à la Kate Middleton, complete with perfectly styled hair, eyelash extensions, and a serenely snoozing newborn.
I’d be heading out on long family walks, pushing the pram, within 48 hours of giving birth.
My tummy would magically flatten itself within maybe, say, 3 days of the baby arriving.
Let the record state that I’m not an idiot. (No, really.) But depictions of life after birth, as shown in the movies and via glossy social media feeds, led me to believe the biggest issue I’d face would be a bit of blood and finding a concealer industrial-strength enough to tackle the inevitable shadows under my eyes.
It was only when I found myself consulting “Dr. Google” at 2 a.m. that I realised exactly how little I knew, and how minimal the discussion is about our bodies postbirth — what is and isn’t normal, what help is available, and what you can do to help yourself feel better.
For women who don’t have the headspace to wonder how they can, say, diagnose — or fix — a tummy gap, it can be all too easy to just assume that this is just the penalty for having a baby while questioning every twinge or odd sensation and consulting online forums that only ever imply the worst.
This has a knock-on effect, of course. The physical strain of postbirth symptoms can all too easily influence a woman’s mood, with stress and anxiety blending with sleep deprivation and a hormonal cocktail to result in depression.
Factor in a wailing newborn and unwanted opinions thrown in from every angle, and it’s quite easy to see why, for some women, it’s simply too much to handle.
While the cutesy-sounding baby blues are common, so too is postnatal depression, which affects as many as 1 in 10 women within the first year of giving birth, according to the U.K.’s National Health Service (NHS). It can affect dads, too.
National Health Service (NHS)
Finding the help we need
If you’ve recently given birth and aren’t quite sure if everything feels right or not, you have options. These include:
Speaking to a medical professional: In England, for example, a new mother will have a few appointments with health visitors and midwives in the weeks immediately following her birth. These mostly focus on the baby but can present an opportunity to ask any questions about your own recovery. Women can also book a 6-week checkup with their GP, although this can be very brief, so go prepared with questions in advance.
Booking yourself in for a “mummy MOT“: These private examinations can offer reassurance or advice if you’re concerned about your stomach or pelvic floor post birth.
Asking for a referral: If you’re adamant something isn’t right, you can ask to be referred to the relevant medical department, although it’s worth remembering that waiting lists can be long, so ‘going private’ might be preferable if you can afford it.
Postbirth issues can be embarrassing to discuss — nobody really wants to talk about constipation or incontinence, do they? — and so many suffer in silence, stoically shouldering anxiety about their battered pelvic floors or exhaustion-frazzled minds. So, what’s the answer?
constipation
incontinence
For one thing, we need to push past the fog of newborn life and stay clear minded when it comes to listening to our bodies. If something feels strange or uncomfortable, you need to talk with your doctor. Suffering in silence helps neither you nor your baby.
Discussing your issue might make you want to curl up in a ball, but it’s worth remembering that:
you’re not the first person to have this issue
the professionals have seen it all countless times before
asking for help is the first step toward recovery
So why do we find it so embarrassing? Because it’s not a widely acknowledged part of the conversation.
Imagine how different pregnancy would feel if we didn’t speak about morning sickness or Braxton-Hicks? Similarly, if the fourth trimester was discussed as openly — be it in prenatal classes, healthcare appointments, or in pop culture — we’d not only be more aware of what entailed, but we’d also feel less alone when confronted with it.
morning sickness
Braxton-Hicks
Conversations surrounding the realities of post-birth life need to open up. As comfortable as we are talking about our babies, so too should we be comfortable discussing our recoveries.
Talking about it with friends or a professional can work wonders, opening you to the realization that you’re not the first person to have experienced what you’re feeling, no matter how isolating and lonely it might feel.
American actress Amanda Seyfried recently spoke out about the issue of the fourth trimester in America, telling talk show host Seth Meyers, “As soon as you have a baby, you go home, and that’s it. There’s no fourth trimester checkins… We don’t talk about it enough.”
Fundamentally, it’s an issue that unites mothers around the world.